Depression in Late Life Initiative

Transcription

1 Depression in Late Life Initiative made possible by the Archstone Foundation Depression in Late Life Request for Proposals (RFP) Care Partners: Bridging Families, Clinics, and Communities to Advance Late Life Depression Care Phase 2, Cohort 2. October 23, 2017

2 Care Partners Team Laura Rath, MSG, Archstone Foundation Senior Program Officer Jürgen Unützer, MD, MPH, MA, University of Washington Investigator, Care Partners Ladson Hinton, University of California, Davis Investigator, Care Partners Theresa Hoeft, PhD, University of Washington Investigator, Care Partners Mindy Vredevoogd, University of Washington Project Manager, Care Partners 2

3 Outline of Webinar Background on Archstone Foundation and Depression in Late Life Initiative Need to improve late life depression care Collaborative care in primary care or out in the community Innovative approaches involving community partners Phase 2 RFP: Implementing innovative approaches to treating depression in older adults through the following three types of partnerships: Collaborative Care Primary Care Clinic CBO Partnership PEARLS CBO Primary Care Clinic Partnership Collaborative Care Primary Care Clinic Family Partnership Application Details Q & A

4 Archstone Foundation The Archstone Foundation is a private grantmaking organization whose mission is to contribute toward the preparation of society in meeting the needs of an aging population.

5 Depression in Late Life Initiative Initiative to improve depression care in late life Phase 1, Cohort 1 Phase 2, Cohort 2 Funding to UW and UC Davis to support: Care Partners: Bridging Families, Clinics, and Communities to Advance Late Life Depression Care Support from UW and UC Davis: Developing the Request for Proposals (RFP) Assistance in the selection process Offering support to applicants and awardees Fostering a learning community among awardees 5

6 Jürgen Unützer, MD, MPH, MA University of Washington Professor and Chair, Department of Psychiatry and Behavioral Sciences Leader on the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) trial for late life depression in primary care Director, Advancing Integrated Mental Health Solutions (AIMS) Center Worked with > 1000 clinics to improve depression care Share with you background on: Need to improve late life depression care 6 Collaborative care

7 Depression Pervasive depressed mood/ sadness (or) Loss of interest / pleasure Lack of energy, fatigue, poor sleep and appetite, physical slowing or agitation, poor concentration, physical symptoms (aches and pains), irritability, thoughts of guilt, and thoughts of suicide 5 10 % of older primary care patients A miserable state that can last for months or years

8 Depression and mortality

9 How good is current depression care? Fewer than 2/10 see a psychiatrist or psychologist 5/10 receive treatment in primary care The 2 minute mental health visit (Ming Tai Seale, 2008) 4 5 million older adults receive an antidepressant prescription, but only 20 % improve Few get effective psychotherapy 9

10 Collaborative Care Primary Care Practice with Mental Health Care Manager Outcome Measures Treatment Protocols Population Registry Psychiatric Consultation 10

11 Collaborative Care doubles effectiveness of care for depression 50 % or greater improvement in depression at 12 months 70 Usual Care IMPACT % improvement Unützer et al., JAMA 2002; Psych Clin NA Participating Organizations

12 Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) Collaborative care in the community Highly effective method designed to reduce depressive symptoms and improve quality of life in older adults In home sessions with brief behavioral techniques Part of existing community based program that already deliver care and provide resources to clients Incorporates current approaches to chronic illness care, including the Chronic Care Model and Collaborative Care Evidence based: PEARLS participants were more likely to have a significant reduction in depression and an improvement in functional and emotional wellbeing (JAMA Apr 7;291(13): ) 12

13 Ladson Hinton, MD University of California Davis Professor, Department of Psychiatry and Behavioral Sciences Developing family focused interventions for treating late life depression Coaching for interventions involving family as care partners Involving families of older adults with chronic illness has potential for improving care for chronic illness and depression (Wolff 2012; Hinton et al. 2014) Share background on: Promise of involving care partners to improve care 13

14 Promise of involving care partners to improve care Involving CBOs and family/friends can improve: Access to care Engagement in treatment Patient care experience Quality of care We know collaborative care is effective Looking for ways partnerships between primary care clinics and community resources can enhance collaborative care Care partners might help with aspects of screening, diagnosis, patient education, case management to address unmet needs, medication management and/or brief psychotherapy Additional support from care partners might be focused on more complex or vulnerable populations (e.g., home visits, case management) (See Resources section for background) 14

15 Traditional Care Primary Care Provider (PCP) Patient 15

16 Collaborative Care (IMPACT or PEARLS) PCP Patient Care Manager Psychiatric Consultant 16

17 Engaging Family & Friends or CBO PCP Patient Care Manager Psychiatric Consultant Family or CBO 17

18 Phase 1 Partnership Examples Primary Care CBO Sonoma County Adult and Aging Services and FQHC clinic, Petaluma Health Center Enhancement to collaborative care in primary care: PEARLS Home visiting care manager from Sonoma Co. offers behavioral activation and case management services in the home and by phone Care manager integrated into the clinic setting, EHR, and joins weekly case review calls with the psychiatric consultant El Sol Neighborhood Educational Center and Professional Family Counseling Implementing PEARLS program including more active collaboration with primary care (e.g., referrals and patient updates) Primary Care Family VA McClellan and Fairfield clinics are partnering with family care partners Enhancement to collaborative care in primary care: Family are actively involved in helping with medication management, behavioral activation, etc. 18

19 Quote actually offering those services really forces us to look around to say, are we the best person to do that, or is someone else in the community already doing it and really excelling at it? So this grant was really an opportunity for us to formally partner with a community agency that we knew was offering amazing services to our patients, actually, in somewhat of a silo. So we had communication with them around patients, but it was very limited. And we certainly weren't working together in a collaborative care model to include them. I think the importance of community partnership really can't be overstated. So health centers are never really going to have the ability to offer every single service to our patients without having those collaborations are really critical for community health. CMO at primary care clinic 19

20 Theresa Hoeft, PhD University of Washington Assistant Professor, Department of Psychiatry and Behavioral Sciences Health Services Researcher / Health Economist with degree more broadly in Population Health Community engaged research with clinics and communities Share with you background on: RFP for Care Partners 20

21 Care Partners Request for Proposals Care Partners: Bridging Families, Clinics, and Communities to Advance Late Life Depression Care Funding Opportunities: Collaborative Care Primary Care Clinic CBO Partnership PEARLS CBO Primary Care Clinic Partnership Collaborative Care Primary Care Clinic Family Partnership Developing innovative ways to share collaborative care tasks among partners and possibly across settings 21

22 Funding Opportunity: CBO Primary Care Clinic Primary care clinic partnering with a CBO awards will be funded up to $150,000 per year for two (2) years and $75,000 in year three (3) for a total of $375,000 divided between the partners. Collaborative Care Team Collaborative Care Task Matrix - CBO and Primary Care Clinic Primary Care Clinic Who will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in Community- Prescribing Non- Other performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by Patient Psychiatric Based Provider Prescribing Partners someone. Consultant Ogranization (PCP) Provider Identify Patients with Depression in Care T ask 1. Identify people who may need help T ask 2. Screen for depression Initiate and Provide Treatment for Depression T ask 3. Gather information to support a clinical assessment T ask 4: Diagnose depression T ask 5. Educate patient about depression T ask 6. Educate patient about treatment options T ask 7. Engage patient in depression treatment T ask 8. Develop and initiate a treatment / care plan T ask 9. Prescribe antidepressant medication, if indicated T ask 10. Educate patient about medications & other treatment side effects T ask 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment moda Task 12. Provide evidence-based psychotherapy (e.g., PST, CBT, IPT), if indicated T ask 13. Provide case management or refer to social and other support services (e.g. housing, food assistance), if indicated T ask 14. Provide or refer to specialty mental health services outside primary care, if indicated Track Processes of Care and Clinical Outcomes T ask 15. T rack treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatment T ask 16. T rack delivery of care management support in a registry (e.g. follow-up calls to patients, clinic appointments, case reviews by psychiatric consultant, referrals) T ask 17. Reach out to patients not engaging in treatment Adjust Treatment if Patients are Not Responding T ask 18. Regularly check treatment response and cue providers for possible changes in treatment, if needed T ask 19. Participate in regular (weekly) case review to identify patients who are not improving and provide treatment recommendations T ask 20. Ensure treatment recommendations get to provider and are enacted Provide Administrative Support and Program Supervision Task 21. Provide program support (e.g., scheduling, resources) Task 22. Provide program supervision Task 23. Attend regular planning meetings between the CBO and primary care clinic 22

23 Funding Opportunity: PEARLS CBO Primary Care Clinic CBO delivering a PEARLS program partnering with primary care clinic(s) awards will be funded up to $150,000 per year for two (2) years and $75,000 in year three (3) for a total of $375,000 divided between the partners. PEARLS Task Matrix - CBO and Primary Care Clinic Who will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by someone. Identify Patients with Depression in Care Patient Care Team PEARLS Providers PEARLS Psychiatric Other Staff at Counselor Consultant CBO Primary Care Clinic Other Partners T ask 1. Identify people who may need help T ask 2. Screen for depression Initiate and Provide Treatment for Depression T ask 3. Gather information to support a clinical assessment T ask 4: Diagnose depression T ask 5. Educate patient about depression T ask 6. Educate patient about treatment options T ask 7. Engage patient in depression treatment T ask 8. Develop and initiate a treatment / care plan in coordination with primary care T ask 9. Communicate with clinic provider and support antidepressant treatment, if antidepressant medication indicated T ask 10. Educate patient about medications & other treatment side effects T ask 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment moda T ask 12. Provide evidence-based PST /BA T ask 13. Provide case management or refer to social and other support services (e.g. housing, food assistance), if indicated T ask 14. Provide or refer to specialty mental health services, if indicated Track Processes of Care and Clinical Outcomes T ask 15. T rack treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatment T ask 16. T rack delivery of care management support in a registry (e.g. follow-up calls to patients, clinic appointments, case reviews by psychiatric consultant, referrals) T ask 17. Reach out to patients not engaging in treatment Adjust Treatment if Patients are Not Responding T ask 18. Regularly check treatment response and cue providers for possible changes in treatment, if needed T ask 19. Participate in regular (weekly) case review to identify patients who are not improving and provide treatment recommendations T ask 20. Ensure treatment recommendations get to the PCP or other related provider and are enacted Provide Administrative Support and Program Supervision T ask 21. Provide program support (e.g., scheduling, resources) T ask 22. Provide program supervision T ask 23. Attend regular planning meetings between the CBO and primary care clinic 23

24 Funding Opportunity: Primary Care Clinic Family Primary care with family care partner awards will be funded up to $150,000 in year one (1), $100,000 in year two (2), and $75,000 in year three (3) for a total of $325,000. Collaborative Care Task Matrix - Family Intervention Who will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by someone. Collaborative Care Team Primary Care Clinic Prescribing Non- Patient Psychiatric Provider Prescribing Consultant (PCP) Provider Family-focused Intervention Family Member, Friend, or Significant Other Identify Patients with Depression in Care Task 1. Identify people who may need help T ask 2. Screen for depression Initiate and Provide Treatment for Depression T ask 3. Gather information to support a clinical assessment Task 4: Diagnose depression Task 5. Educate patient and family (as appropriate) about depression Task 6. Educate patient and family (as appropriate) about treatment options Task 7. Engage patient and family (as appropriate) in Collaborative Care for depression Task 8. Develop and initiate a treatment / care plan Task 9. Prescribe antidepressant medication, if indicated Task 10. Educate patient about medications & other treatment side effects Task 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment modality Task 12. Provide evidence-based psychotherapy (e.g., PST, CBT, IPT), if indicated Task 13. Provide case management or refer to social and other support services (e.g. housing, food assistance), if indicated Task 14. Provide or refer to specialty mental health services outside primary care, if indicated Track Processes of Care and Clinical Outcomes Task 15. Track treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatments) Task 16. Track delivery of care management support in a registry (e.g. follow-up calls to patients, clinic appointments, case reviews by psychiatric consultant, referrals) Task 17. Reach out to patients not engaging in treatment Adjust Treatment if Patients are Not Responding T ask 18. Regularly check treatment response and cue providers for possible changes in treatment, if needed Task 19. Participate in regular (weekly) case review to identify patients who are not improving and provide treatment recommendations Task 20. Ensure treatment recommendations get to provider and are enacted Provide Administrative Support and Program Supervision Task 21. Provide program support (e.g., scheduling, resources) Task 22. Provide program supervision Other Partners 24

25 Collaborative Care Primary Care Clinic Family Proposals with family members should include substantial family involvement One example involving family members: Engaging patients in depression in care Facilitate evidencebased depression treatment Track processes of care and clinical outcomes Collaborative Care Task Matrix - Family Intervention Who will do these tasks? Please mark an 'x' below where appropriate. Multiple people/organizations may be involved in performing the same task so it's ok to mark multiple x's in the same row. Note: Most but not all tasks need to be performed by someone. Collaborative Care Team Primary Care Clinic Prescribing Non- Patient Psychiatric Provider Prescribing Consultant (PCP) Provider Family-focused Intervention Family Member, Friend, or Significant Other Identify Patients with Depression in Care T ask 1. Identify people who may need help T ask 2. Screen for depression Initiate and Provide Treatment for Depression T ask 3. Gather information to support a clinical assessment T ask 4: Diagnose depression T ask 5. Educate patient and family (as appropriate) about depression T ask 6. Educate patient and family (as appropriate) about treatment options T ask 7. Engage patient and family (as appropriate) in Collaborative Care for depression T ask 8. Develop and initiate a treatment / care plan T ask 9. Prescribe antidepressant medication, if indicated T ask 10. Educate patient about medications & other treatment side effects T ask 11. Facilitate patient self-management support and behavioral interventions for all patients regardless of treatment modality T ask 12. Provide evidence-based psychotherapy (e.g., PST, CBT, IPT ), if indicated T ask 13. Provide case management or refer to social and other support services (e.g. housing, food assistance), if indicated T ask 14. Provide or refer to specialty mental health services outside primary care, if indicated Track Processes of Care and Clinical Outcomes T ask 15. T rack treatment outcomes using a registry (e.g. symptoms with the PHQ-9, outcome of referrals and other treatments) T ask 16. T rack delivery of care management support in a registry (e.g. follow-up calls to patients, clinic appointments, case reviews by psychiatric consultant, referrals) T ask 17. Reach out to patients not engaging in treatment Adjust Treatment if Patients are Not Responding T ask 18. Regularly check treatment response and cue providers for possible changes in treatment, if needed T ask 19. Participate in regular (weekly) case review to identify patients who are not improving and provide treatment recommendations T ask 20. Ensure treatment recommendations get to provider and are enacted Provide Administrative Support and Program Supervision T ask 21. Provide program support (e.g., scheduling, resources) T ask 22. Provide program supervision Other Partners 25

26 Eligible Criteria California non profit 501(c)(3) primary care clinics and nonprofit 501(c)(3) CBOs are eligible to apply if they have an established (i.e., existing) collaborative care program in primary care or PEARLS program in the community as defined by the description on page 3 of RFP Currently offer services to older adults (65 years of age and older) Have the capacity to offer partnered care to at least 100 older adults with depression over 3 years See RFP for complete eligibility criteria and list of special activities 26

27 Collaborative Care Collaborative care services must include: Screening for depression Depression diagnosis Patient education and engagement Treatment, and treatment support, as appropriate to each patient (For examples, refer to the Collaborative Care Task Matrix and PEARLS Task Matrix appendices) Systematic tracking of depression outcomes using the PHQ 9 depression measure (Patient Health Questionnaire 9 item version) using a registry Regular psychiatric case review with recommendations for treatment adjustment if patients are not improving 27

28 Budgeting Considerations Budgets should reflect funding and project tasks for each partner organization A maximum of 10% is allowable for indirect costs See RFP for other considerations such as travel to meetings, including initial in person training Applicants do not need to budget for collaborative care training and ongoing implementation support/coaching. This will be provided by UW and UC Davis if additional training is needed. 28

29 Technical Assistance and Coaching to Awardees The team at UW and UCD will provide: Collaborative care training and ongoing coaching to support projects (e.g., Problem Solving Treatment training as needed) Registry (i.e., Care Management Tracking System) 29

30 Resources Collaborative Care in Primary Care IMPACT: improving mood promoting access collaborativetreatment/ Care Partners Website: Innovations in Late life Depression Care Partnering with CBOs Community services for high need patients: care for highneed patients/ Community services for socially at risk populations: Practices for the Careof Socially At Risk Populations.aspx Innovations in Late life Depression Care Partnering with Family New link to article: PEARLS 30

31 Application Timeline October 11, 2017 October 23, 2017 December 14, 2017 March 8, 2018 March June 2018 June 2018 July 1, 2018 RFP/LOI Office Hours (11am 12pm PST) RFP Webinar Letter of Inquiry (LOI) Due Full Proposals Due Review Process/Site Visits Approval & Notification of Awards Grant Period Begins 31

32 Contact Information Laura Rath, MSG, Archstone Foundation Application logistics and submittal contact: Mindy Vredevoogd, University of Washington Application content areas (task matrices, eligibility, resources, etc) contact: 32

33 33 Questions and Answers